EuHEA Seminar Series Fall 2021

The EuHEA seminar series brings together health economists all across its member associations, and beyond, to discuss cutting-edge research

Welcome

The EuHEA Seminar Series aims to foster exchange between health economists across different countries and institutions and present cutting-edge research in all areas of health economics. A Scientific Committee chaired by Rossella Verzulli (University of Bologna) will coordinate the series for the academic year 2021/2022.

Please note that the time slot for the EuHEA Seminar Series in fall will change to Wednesdays, 2:30-3:30pm (CET), program details and a link for registration will follow here.

Registration is free, using this link. After registering, you will receive a confirmation email containing information about joining the meeting. If you have already registered for the past seminars scheduled on October 13 or onwards, you don’t need to register again.

Upcoming event

8 December 2021, 14:30-15:30 (CET)

Putting a price on air pollution

I estimate the causal effects of air pollution on healthcare costs in France by combining administrative data on healthcare reimbursements with reanalysis data on air pollution concentrations and weather conditions. I adopt an instrumental variable approach where I exploit daily postcode-level variation in nitrogen dioxide, ground-level ozone and particulate matter concentrations induced by variation in wind speed. I explore effect heterogeneity by patient and location characteristics and by medical speciality. This study presents evidence for substantial healthcare costs caused by exposure to pollution levels that are predominantly situated below current European legal limits. The effects are several orders of magnitude larger than those estimated in the previous literature, suggesting that the healthcare costs of air pollution have been severely underestimated. I find significant heterogeneity of effects across location and patient characteristics, indicating that air pollution reduction policies have the potential to reduce health inequalities.

Speaker: Julia Mink, Sciences Po University and French National Institute for Agricultural Research
Discussant: Shushanik Margaryan, University of Potsdam
Chair: Sverre Kittelsen, University of Oslo

Program

29 September 2021, 14:30-15:30 (CET)

Dynamic Impacts of Lockdown Mandates on Intimate Partner Violence: Evidence from Multiple Policy Shifts in Chile

There has been a global surge in domestic violence (DV) during the pandemic. We identify impacts of lockdown imposition and lockdown removal on measures of incidence and reporting using Chilean administrative data. Chile provides a good laboratory for this analysis because lockdown was staggered across its 346 municipalities. We defend the identifying assumption that the timing of lockdown is quasi-random and obtain estimates of dynamic effects that are unbiased under treatment effect heterogeneity. We find an increase in incidence alongside a decrease in reports to the police. Investigating mechanisms, we find evidence consistent with mobility restrictions and job loss being exacerbated by lockdown and contributing to the increase in DV.  We estimate that formal job loss may explain around 10 percent of the sharp rise in DV distress calls.  We observe ratchet effects, with the lifting of lockdown only partially reversing the spike in distress calls and employment. Our findings accentuate the controversy around welfare impacts of lockdown imposition.

Speaker: Damian Clarke, University of Chile
Discussant: Pinar Keskin, Wellesley College
Chair: Rossella Verzulli, University of Bologna

6 October 2021, 14:30-15:30 (CET)

The Medium-Term Impact of Prenatal Exposure to Air Pollution

We investigate the medium-term effects of prenatal exposure to moderate air pollution on health matching satellite estimates of PM10 concentration with administrative longi- tudinal data on the universe of live-births, hospitalisation records and pharmaceutical consumption in a large Italian region. Employing quasi-random variation in PM10 and controlling for weather and economic activity, we show that prenatal exposure to air pollution leads to worse health outcomes at birth and to substantially higher pharma- ceutical consumption and hospitalization rates in early life, especially for less healthy individuals. We rule out in-sample compositional effects and show that the geograph- ical mobility of expectant mothers does not respond to air pollution. The effects of air pollution are long-lasting and entail sizeable monetary costs even at moderate levels.

Speaker: Chiara Serra, Bocconi Univeristy
Discussant: Katharina Janke, Lancaster University
Chair: Daniela Iorio, University of Bologna

13 October 2021, 14:30-15:30 (CET)

A new online tool for valuing health states: eliciting personal utility functions for the EQ-5D-5L

Introduction

Standard valuation methods, such as TTO or DCE are inefficient. They require data from hundreds if not thousands of participants to generate value sets for health descriptive systems. Here, we present the Online elicitation of Personal Utility Functions (OPUF) tool; a new type of online survey for valuing EQ-5D-5L health states using more efficient, compositional preference elicitation methods, which even allow estimating value sets on the individual level. The aims of this study are to report on the development of the tool, and to test the feasibility of using it to obtain individual-level value sets for the EQ-5D-5L.

Methods

We adapted the PUF method, an in-person interview technique, focused on reflection and deliberation, previously proposed by Devlin et al., for use as a standalone online tool. For this, we applied an iterative design approach: five rounds of qualitative interviews, and one quantitative pre-pilot were conducted to get feedback on the different tasks. After each round, the tool was refined and re-evaluated. The final version of the OPUF Tool was then piloted in a sample of 50 participants from the UK.

Results

On average, it took participants about seven minutes to complete the OPUF Tool. Based on the responses, we were able to construct a personal utility function for each of the 50 participants. The utility functions predicted a participant’s choices in a (validation) discrete choice experiment with an accuracy of 80%. Overall, the results revealed that health state preferences vary considerably on the individual-level. Nevertheless, we could estimate a group-level value set with reasonable precision. The two most important EQ- 5D dimensions were Mobility and Pain/Discomfort.

Discussion

We successfully piloted the OPUF Tool and showed that it can be used to derive a social as well as personal utility functions for the EQ-5D-5L. Even though the development of the online tool is still in an early stage, there are multiple potential avenues for further research.

A demo version of the OPUF Tool is available at: https://eq5d5l.me

Speaker: Paul Schneider, University of Sheffield
Discussant: Monica Duarte Oliveira, Universidade De Lisboa
Chair: Dorte Gyrd-Hansen, University of Southern Denmark

20 October 2021, 14:30-15:30 (CET)

The formation of physician altruism

This paper studies how patient-regarding altruism is affected by medical education. We present structural estimates on experimental data from a large sample of German medical students (N=733) varying in their study progresses. The estimates reveal substantial heterogeneity in altruistic preferences across study cohorts. Patient-regarding altruism is highest for freshmen, significantly declines for students in the pre-clinical and clinical study phase, and tends to increase for practical-year students, who assist in clinical practice. Across individuals, patient-regarding altruism is higher for females and increases in general altruism. Altruistic subjects have lower income expectations and are more likely to choose surgery and pediatrics as their preferred specialty.

Speaker: Daniel Wiesen, University of Cologne
Discussant: Jing Li, Cornell University
Chair: Francesca Barigozzi, University of Bologna

27 October 2021, 14:30-15:30 (CET)

Depowering Risk: Vehicle Power Restriction and Teen Driver Accidents in Italy

This paper investigates the road safety impact of an Italian law that sets a limit on vehicle power for first-year licensees. We leverage the between-cohort differences in exposure to the reform to determine its effect on traffic accidents. We find that, when prevented from using high-powered cars, teen drivers are 13% less likely to cause an accident and 28% less likely to cause a fatal accident, mainly because of fewer speed violations. These effects persist even after the one-year restriction expires. Our findings highlight the effectiveness of policies that, instead of directly targeting risky behaviours, reduce exposure to high-risk settings.

Speaker: Silvia Balia, University of Cagliari
Discussant: Thomas Siedler, University of Potsdam
Chair: Matteo Lippi Bruni, University of Bologna

3 November 2021, 14:30-15:30 (CET)

The role of financial literacy when paying for aged care

Deciding how to pay for accommodation when entering residential aged care in Australia is complex. It can impact the residents’ income, savings and wealth, along with their bequest value. Many older Australians and their informal carers lack financial literacy, which increases the likelihood of making suboptimal accommodation payment decisions. This may be exacerbated by cognitive decline. Our study examines how the financial literacy of informal carers impacts accommodation payment decisions made by Australians when entering residential aged care. It draws on an Australia wide survey to measure financial literacy among informal carers who helped residents make their accommodation payment decision. We used a set of regressions to estimate the relationship between the respondent characteristics and financial literacy, financial literacy and financial adviser use, and financial literacy and accommodation payment decision confidence, complexity, and stress. We found less than half of respondents were financially literate. Many exhibited underconfidence in their financial literacy, while others were overconfident. Both may lead to suboptimal accommodation payment decisions. We found aged care providers had a greater impact on using a financial adviser than financial literacy, suggesting a principal-agent relationship exists. Our results suggest higher financial literacy may reduce some decision complexity but its relationship with decision confidence was weak and its relationship with decision stress was not significant. These relationships were moderated by the perceived time available to decide on an accommodation payment. Increasing financial literacy is unlikely to substantially help people make a better accommodation payment decision. Increasing access to financial advice may reduce the likelihood of making suboptimal decisions, but limited trust and anxiety with using a financial adviser means there is no guarantee that people would use this service. Making the accommodation payment choice simpler may increase welfare by reducing the potential to make a suboptimal accommodation payment decision and reducing decision stress.

Speaker: Henry Cutler, Macquarie University Centre for the Health Economy
Discussant: Anne Nolan, Trinity College Dublin and Economic and Social Research Institute
Chair: Geir Godager, University of Oslo

10 November 2021, 14:30-15:30 (CET)

The Power of Markets: Impact of Desert Locust Invasions on Child Health

This paper investigates the consequences of a locust plague that occurred in Mali in 2004. We argue that in agricultural economies with a single harvest per year, this type of shock can affect households through two channels: first, a speculative/anticipatory effect that kicks in during the growing season, followed by a local crop failure effect after harvest. We show that, in terms of health setbacks, children exposed in utero only to the former suffered as much as those exposed to the latter. We also document a substantial impact of the plague on crop price inflation before the harvest, as well as a stronger crop failure effect for children born in isolated areas.

Speaker: Bruno Conte, University of Bologna
Discussant: Cristina Borra, University of Seville
Chair: Davide Dragone, University of Bologna

17 November 2021, 14:30-15:30 (CET)

Tracking the evolution of EQ-5D values due to demographic change over a 50-year period

Objectives National EQ-5D value sets are used to guide healthcare resource allocation, with the justification being that they represent the general public’s preferences. Value sets can remain in use for a long time, particularly in the UK where health technology assessment still uses values from 1993. There are concerns that over time value sets may no longer reflect the public’s preferences, but there is little understanding of why and how health preferences evolve over time. Many disparate factors can have an influence, including demographic changes, evolving societal attitudes and advances in preference measurement technology. We present a method which disentangles the influence on EQ-5D value sets of demographic shifts, e.g. an ageing population, from other potential sources such as changing attitudes or different measurement techniques.

Methods In 2018 an EQ-5D-5L valuation exercise was carried out using a discrete choice experiment with values anchored to the full health=1, dead=0 scale using a visual analogue scale (VAS) exercise. The influence of two sets of demographic char- acteristics was estimated: (1) age and gender; (2) a range of characteristics including age, gender, occupation, number of children and long-term health conditions. For (1), DCE responses were analysed using multinomial logit, for (2) DCE responses were anal- ysed using the least absolute shrinkage and selection operator (LASSO). In both cases VAS responses were analysed using linear regression. Data from the Office for National Statistics was used to re-weight values to match the UK population’s characteristics in terms of the first set of characteristics, i.e. age and gender, in each year from 1990-2040. The Health Survey for England was used to re-weight values to match the population in terms of the second set of characteristics in each year from 1993-2018.

Results All demographic characteristics included in the analysis influenced survey re- spondents’ valuation of at least one EQ-5D-5L level. However, values remained largely stable over time. The greatest changes between 1990 and 2040 were seen for anxi- ety/depression level 4, at -0.016 and self-care level 4, at -0.010. Including a wider range of characteristics sometimes influenced whether the utility decrement associated with a level increased or decreased over time.

Conclusion No evidence was found that demographic shifts affect EQ-5D-5L values, even over a 50 year period. The method is generalisable, and similar exercises could inform future EQ-5D life-cycle research.

Speaker: Edward Webb, University of Leeds
Discussant: David Mott, Office of Health Economics
Chair: Liza Sopina, University of Southern Denmark

24 November 2021, 14:30-15:30 (CET)

Global Drug Diffusion and Innovation with the Medicines Patent Pool

This paper studies the impact of the first joint licensing platform for patented drugs, the Medicines Patent Pool, on global drug diffusion and innovation. The pool allows generic firms worldwide to license drug bundles cheaply and conveniently for sales in a set of developing countries. I construct a novel dataset from licensing contracts, public procurement, clinical trials, and drug approvals. Using difference-in-differences methods, I find that the pool leads to substantial increases in the generic supply of drugs purchased. In addition, R&D inputs and outputs respond positively overall. The estimated benefits to consumers and firms far exceed the operating costs.

Speaker: Lucy Xiaolu Wang, Cornell University
Discussant: Laura Magazzini, Sant'Anna School of Advanced Studies
Chair: Paolo Pertile, University of Verona

1 December 2021, 14:30-15:30 (CET)

Wage Expectations and Effort of Prospective Healthcare Professionals: Evidence from a Randomized Experiment

The steady increase of population aging and the current pandemic outbreak are exacerbating the shortage of health sector employees, both medical doctors and healthcare professionals. In this paper, we conduct a randomized experiment with 279 applicants to medical and healthcare schools in Italy, where admission is subject to passing a competitive test. We first elicit applicants' beliefs about wages in the health sector and then inform the treatment group about the actual levels of entry wages. We find that correcting wage beliefs enhances the applicants' test score, only if they expect a lower wage level than the actual one. Our result suggests that wage matters for prospective health sector employees.

Speaker: Alessandro Fedele, Free University of Bozen-Bolzano
Discussant: Daniel Wiesen, University of Cologne
Chair: Tor Iversen, University of Oslo

8 December 2021, 14:30-15:30 (CET)

Putting a price on air pollution

I estimate the causal effects of air pollution on healthcare costs in France by combining administrative data on healthcare reimbursements with reanalysis data on air pollution concentrations and weather conditions. I adopt an instrumental variable approach where I exploit daily postcode-level variation in nitrogen dioxide, ground-level ozone and particulate matter concentrations induced by variation in wind speed. I explore effect heterogeneity by patient and location characteristics and by medical speciality. This study presents evidence for substantial healthcare costs caused by exposure to pollution levels that are predominantly situated below current European legal limits. The effects are several orders of magnitude larger than those estimated in the previous literature, suggesting that the healthcare costs of air pollution have been severely underestimated. I find significant heterogeneity of effects across location and patient characteristics, indicating that air pollution reduction policies have the potential to reduce health inequalities.

Speaker: Julia Mink, Sciences Po University and French National Institute for Agricultural Research
Discussant: Shushanik Margaryan, University of Potsdam
Chair: Sverre Kittelsen, University of Oslo

15 December 2021, 14:30-15:30 (CET)

Fair Pension Policies with Occupation-Specific Aging

     

Speaker: Johannes Schünemann, University of Fribourg
Discussant: Davide Dragone, University of Bologna
Chair: Oddvar Kaarbøe, University of Bergen

Scientific Committee

The EuHEA Seminar Series in the academic year 2021/2022 is coordinated by:

  • Rossella Verzulli, University of Bologna (Chair)
  • Pedro Pita Barros, Universidade Nova de Lisboa (Co-Chair)
  • Francesca Barigozzi, University of Bologna
  • Stefan Boes, University of Lucerne
  • Davide Dragone, University of Bologna
  • Geir Godager, University of Oslo
  • Dorte Gyrd-Hansen, University of Southern Denmark
  • Daniela Iorio, University of Bologna
  • Tor Iversen, University of Oslo
  • Oddvar Kaarboe, University of Bergen
  • Sverre Kittelsen, Frisch Centre
  • Matteo Lippi Bruni, University of Bologna
  • Paolo Pertile, University of Verona
  • Liza Sopina, University of Southern Denmark